Provider Demographics
NPI:1700082310
Name:CODY, CHRISTIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15583 580TH AVE
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-8718
Mailing Address - Country:US
Mailing Address - Phone:515-547-2296
Mailing Address - Fax:
Practice Address - Street 1:508 2ND ST NE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:IA
Practice Address - Zip Code:50530-7530
Practice Address - Country:US
Practice Address - Phone:515-547-2296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist